The Senate bill, universally despised by the left and the right and likely about to be by those learning about it via any mainstream news channel, will head to conference committee after three cloture votes and one up or down vote.
Rather than indulge in criticism, it might be better to think about what key bargaining points between the House and Senate bills there are, and a strategy to apply pressure. Here are the ones I see:
- Public option – The House bill has one; the Senate bill doesn’t. The House bill public option is not opt-out, and appears to have more cost savings attached to it than the Senate alternative placed under the auspices of the OPM.
- Abortion language – The House bill has the odious Stupak language; the Senate bill has a much less onerous version that involves allowing states to opt-out of abortion coverage in the state exchanges.
- Exchange structure – The House bill is a national exchange, which will yield stronger cost controls. The Senate bill is a state-based exchange, which leaves most of the regulations in the hands of the states (which hasn’t been great up to now).
- Antitrust exemption – The House bill revokes the antitrust exemption insurers have enjoyed for all these years. The Senate bill does not.
- Accelerated effective dates – The House bill accelerates the effective date for ending pre-existing conditions exclusions. The Senate bill ends those exclusions in 6 months for children under age 19, but keeps the 2014 effective date for everyone else.
- Rate disparities for age – The House bill has a 2:1 ratio for age; the Senate bill has a 3:1 ratio.
- Funding methods – The House bill has the tax on wage earners over $350,000; the Senate bill taxes Cadillac plans. I think the rich tax could be sold as a sunset of the Bush tax cuts easily enough, but there are some legitimate concerns that the ‘Cadillac plan’ tax places a burden on the middle class working person.
- Mandates – The House bill has a harsher mandate than even the beefed-up Senate bill.
I’m sure there are more than I’ve listed here, but these are the ones that immediately came to mind. Here’s my take: The two biggest chips on the table are the Stupak amendment and the public option.
Assuming there is some way to slip a public option through a cloture vote (at this point, maybe reconciliation for the whole thing after it passes, I don’t know…), my guess is that the public option will be the trade for the Stupak language.
There are some pretty large pieces on the table to move around. But there’s no question in my mind that the largest are the public option for the left, and the Stupak amendment for the right. The rest is likely to land somewhere in the middle, though I truly believe the effective dates must slide toward this time period in order for it to be sold as something meaningful to people who aren’t wonking the debate like I am.
It’s worth remembering this: the House bill was the version that President Obama favored. It barely passed, and the only way to get the support was to insert the Stupak language.
Now we have the worst-case scenario. What will be traded for what? If a public option is in the final deal alongside the odious Stupak language, will liberals/progressives cheer or jeer? Tell me.
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